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Differentiating Medication Non-Adherence From Underlying Comorbidities 

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The expert panel addresses the common assumption of medication non-adherence in patients with resistant diabetes, provides strategies to differentiate non-adherence from underlying comorbidities contributing to resistance, and discusses the challenges of patients who are post-metabolic surgery, yet experience weight gain and symptom recurrence. 

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Defining Resistant Diabetes 

Hanford Yau, MD, Ralph DeFronzo, MD, Pam Kushner, MD, Honey East, MD, and Christopher Lucci, MD, explore resistant diabetes, share their clinical experience regarding the frequency of this condition, and highlight the role of continuous glucose monitoring in identifying patients who may be resistant, as indicated by prolonged periods of blood glucose levels outside the target range. 

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 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

A new investigation into treatment adherence among a national registry of patients with 

 revealed the first years of care may predict future treatment patterns for the progressive vision condition.

The observational analysis, involving approximately 30,000 patients with glaucoma in Denmark, showed increasing age, female sex, and a low Charlson comorbidity (CCI) index score were the factors most correlated with better adherence to glaucoma treatment.

“This finding may be of importance for physicians informing of the clinical value of adherence in the first and the first two years of treatment and may lead physicians to investigate other intraocular pressure (IOP)-lowering options sooner in patients with poor adherence, particularly among those that are progressing at unsafe rates,” wrote the investigative team, led by Anne Cathrine Falch-Joergensen, PhD, Real World Evidence, Signum Life Science.

Rates of glaucoma are expected to increase dramatically in the coming years, owing to the rapidly aging global population. Often asymptomatic, current rates of affected individuals are presumed to be much higher than what is reported, making adherence to management strategies crucial to curb the long-reaching effects of the chronic disease.

Glaucoma medications have been affected by adherence challenges, resulting from both the asymptomatic nature of the disease and difficulties with eye-drop administration. Poor medication adherence has been linked with a faster progression of visual field loss and could place an undue economic burden on the healthcare system.

This analysis, led by Falch-Joergensen, investigated patterns in treatment adherence in glaucoma, related to predictors of adherence, long-term patterns, and economic consequences of poor adherence. Using the Danish National Patient Register (DNPR), all Danish adults with glaucoma alive and residing in Denmark between 2000 and 2009 were included for analysis.

Glaucoma presence was determined by a minimum of 3 redeemed prescriptions of glaucoma medication or a registered diagnosis of primary open-angle glaucoma (POAG) Patients were followed from their index date for the next 10 years—after exclusions, the baseline population consisted of 30,100 individuals.

Medication adherence was determined by calculating the proportion of days covered (PDC) using the redeemed defined daily dose for 10 years, divided by 365 days. High adherence was defined as a PDC ≥80% and poor adherence as a PDC <80%. Patient comorbidities were obtained from the DNPR, estimated from 5 years before and up to the index date, and operationalized as a CCI score.

Falch-Joergensen and colleagues found that 54.7% of participants adhered to their glaucoma treatment within the first year from the index date. In the first two years from the index date, 51.8% of patients adhered to glaucoma medication.

Upon analysis, high adherence in the first year of treatment was found to be less likely among men (odds ratio [OR], 0.78; 95% CI, 0.75 to 0.82), younger participants, and those with a positive CCI score ≥3 (OR, 0.71; 95% CI, 0.63 to 0.80).

First-year adherence and adherence in the first two years were strongly associated with adherence in the fifth and 10th years from the index date. The most notable association estimates were identified after applying adherence over the first two years, with a strong association in fifth-year adherence (OR, 6.47; 95% CI, 6.10 to 6.86) and slightly lower estimates in the 10th year.

Poorer adherence in the first years of treatment was correlated with higher healthcare costs after 5 and 10 years from the index date. Patients with poor adherence in the first two years had an average cost increase in hospital contacts of €190.77 per patient in the fifth year and €205.16 in the 10th year from the index, compared with those with high adherence. These associations remained statistically significant after adjustment for age, sex, and CCI score.

In their conclusion, Falch-Joergensen and colleagues stressed the need for further investigations into the association between the severity and progression of glaucoma, and poor adherence to treatment, to enhance the current study findings.

“The understanding of the interplay is likewise highly relevant for enhancing the glaucoma treatment, and thus, seeking to prevent the negative consequences of poor medical adherence to glaucoma treatment,” they wrote.

Kolko M, Faergemann Hansen R, G Dal L, et alPredictors and long-term patterns of medication adherence to glaucoma treatment in Denmark—an observational registry study of 30 100 Danish patients with glaucomaBMJ Open Ophthalmology 2024;9:e001607. doi: 10.1136/bmjophth-2023-001607

Articles

The national registry-based analysis in Denmark may inform the clinical value of medication adherence in the first years of glaucoma treatment. 

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Early Adherence to Glaucoma Medication Predicts Future Treatment Patterns

Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

Carl Firth, PhD
Credit: Aslan Pharmaceuticals

Interim data from a phase 2 study of eblasakimab suggests the agent could provide rapid and clinically meaningful itch relief in dupilumab-experienced patients with 

Billed as the first double-blind, placebo-controlled trial conducted in atopic dermatitis patients previously treated with dupilumab, results of the trial indicate the IL-13 receptor α1 antagonist from Aslan Pharmaceuticals could provide significant and sustained reductions in symptoms, with 60% of those in the weekly eblasakimab 400 mg arm achieving at least a 90% reduction in their Eczema Area Severity Index (EASI) score and 66.7% achieving a Validated Investigator Global Assessment (vIGA) score of 0 or 1 after 16 weeks compared to less than 14% of the placebo group, with 20% of patients receiving eblasakimab achieving a 100% reduction EASI score.

“We know that over 60% of dupilumab-treated patients fail to achieve an IGA score of 0 or 1 after 16 weeks1, and, of those patients that do achieve it, still half do not maintain it after the subsequent 36 weeks,” said Carl Firth, PhD, chief executive officer of ASLAN Pharmaceuticals.

 “The data we have announced today provide compelling evidence that eblasakimab, with its unique mechanism of action, has the potential to be an important new therapy for this emerging patient population.”

Boasting a dozen approvals, including indications for atomic dermatitis in children as young as 6 months old, dupilumab has established itself as a cornerstone in the management of inflammatory disorders. However, as is noted by Aslan Pharmaceuticals in their release announcing interim results from the TREK-DX study, approximately 60% of patients receiving dupilumab for atopic dermatitis fail to achieve IGA response. With this in mind, the TREK-DX study was launched to investigate the efficacy and safety of eblasakimab in patients with moderate-to-severe atopic dermatitis who discontinued therapy with dupilumab for any reason. Of note, in June 2023, Aslan Pharmaceuticals announced positive results from the phase 2b TREK-AD study of eblasakimab in biologic-naive patients with moderate-to-serve atopic dermatitis in July 2023.

The primary outcome of interest for the trial was the percentage change in EASI score from baseline to week 16. The trial also included multiple secondary outcomes of interest, such as proportion of patients achieving a vIGA score of 0 or 1, proportion of patients with a 75% or greater reduction in EASI (EASI-75), proportion of patients achieving EASI-50, proportion of patients achieving EASI-90, and changes in peak pruritus.

Analysis of the primary outcome of interest demonstrated use of eblasakimab was associated with a statistically significant difference in rate of EASI score change relative to placebo therapy at week 16 (86.9% vs 51.2%; 

=.0059), despite interim analysis not being powered for statistical significance due to the sample size. Analysis of secondary outcomes indicated use of 73.3% of eblasakimab-treated patients achieved EASI-75 compared to just 14.3% of the placebo group (

Additionally, results suggested 60.0% of eblasakimab-treated patients achieved EASI-90 relative to 14.3% of the placebo group and 20% of eblasakimab-treated patients EASI-100 compared to 0% of the placebo group. For peak pruritus numerical rating scale (PP-NRS) score, a 58.9% mean reduction was observed fromfor eblasakimab-treated patients relative to a 12.9% reduction for placebo-treated patients (

In their release, Aslan Pharmaceuticals called attention to a subgroup analysis of patients with a baseline EASI score of 18 or above, which was an additional inclusion criterion added in October 2023. In this subgroup analysis, which included 15 individuals, use of eblasakimab produced even greater effects on reduction of EASI score, with a mean reduction of 89.2% in EASI score from baseline observed with eblasakimab relative to 45.7% with placebo therapy (

 = .0045). Analysis of secondary outcomes of interest for this group revealed a 61.2% mean reduction in PP-NRS score for eblasakimab-treated patients versus a 1.5% increase for placebo (

“We look forward to announcing the topline readout from the full dataset of the TREK-DX study at the end of this year, the first and only placebo-controlled study of dupilumab-experienced [atopic dermatitis] patients, and to optimizing the dose regimen for patients in the planned phase 3 studies of eblasakimab,” Firth added.

ASLAN Pharmaceuticals. Aslan Pharmaceuticals announces positive interim results from phase 2 study of Eblasakimab in dupilumab-experienced atopic dermatitis patients. ASLAN Pharmaceuticals. April 22, 2024. Accessed April 22, 2024. https://ir.aslanpharma.com/news-releases/news-release-details/aslan-pharmaceuticals-announces-positive-interim-results-phase-2.

Stewart J. Dupixent (dupilumab) FDA approval history. Drugs.com. January 29, 2024. Accessed April 22, 2024. https://www.drugs.com/history/dupixent.html.

ASLAN Pharmaceuticals. Aslan Pharmaceuticals presents new data from phase 2B study of Eblasakimab in atopic dermatitis in late breaker presentation at 32nd European Academy of Dermatology and Venereology Congress. ASLAN Pharmaceuticals. October 13, 2023. Accessed April 22, 2024. https://ir.aslanpharma.com/news-releases/news-release-details/aslan-pharmaceuticals-presents-new-data-phase-2b-study.

Eblasakimab shows promising itch relief in dupilumab-experienced atopic dermatitis patients, with significant reductions in symptoms observed.

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Eblasakimab Shows Benefit in Atopic Dermatitis Among Dupilumab-Treated Patients

The US Food and Drug Administration has approved subcutaneous vedolizumab (Entyvio) for treatment of 

moderately to severely active Crohn disease

, according to an announcement from Takeda Pharmaceuticals.

Announced on April 18, 2024, the approval is based on data from the VISIBLE 2 trial and indicates the agent for maintenance therapy in adults with moderately to severely active Crohn disease after induction therapy with intravenous vedolizumab.

“Crohn’s disease is a complex and usually progressive disease for which an appropriate management plan is critical. My primary goal as a clinician is always to get patients to achieve remission. In VISIBLE 2, about half of patients treated with ENTYVIO SC achieved long-term clinical remission,” said Timothy Ritter, MD, senior medical director, Department of Research and Education, GI Alliance Research and assistant professor of medicine, TCU School of Medicine.

 “The data from VISIBLE 2 reaffirm the well-established efficacy profile of ENTYVIO, regardless of route of administration.”

The approval marks the third approval for vedolizumab and the second in the past 7 months, with the agent receiving an approval for moderate to severe UC. The September 2023 approval for subcutaneous vedolizumab was based on data from the VISIBLE 1 trial, which examined use of the agent among patients with moderate-to-severe ulcerative colitis, indicating use was associated with 46% of patients receiving subcutaneous vedolizumab 108 mg maintenance therapy achieving clinical remission at week 52 compared to 14% of patients receiving placebo (

The VISIBLE 2 study, which served as the basis for the April 18, 2024, approval, was a phase 3, randomized, double-blind, placebo-controlled trial aimed at assessing the safety and efficacy of subcutaneous vedolizumab as maintenance therapy in adult patients with moderately to severely active Crohn Disease. For inclusion in the trial, participants were required to have who had a clinical response at week 6 following 2 doses of open-label vedolizumab intravenous therapy at weeks 0 and 2. Participants were also required to have had an inadequate response to, loss of response to, or intolerance to corticosteroids, immunomodulators, or TNF inhibitors.

A total of 409 patients underwent randomization in a 2:1 ratio to subcutaneous vedolizumab 108 mg administered or placebo every 2 weeks. The primary outcome of interest for the trial was the proportion of patients achieving clinical remission at week 52, which investigators defined as a total Crohn’s Disease Activity Index (CDAI) score of less than 150.

Upon analysis, results of the trial suggested a statistically significant proportion of patients receiving subcutaneous vedolizumab 108 mg maintenance therapy administered every 2 weeks achieved long-term clinical remission relative to the placebo group (48% vs. 34%; 

<.01) at week 52. Safety analyses of the trial indicated the observed safety profile was generally consistent with the known safety profile of intravenous vedolizumab, with the addition of injection site reactions.

“The approval of subcutaneous ENTYVIO in Crohn’s disease delivers on our goal of providing treatment options that can help patients achieve remission of their ulcerative colitis or Crohn’s disease, while also providing them flexibility and choice of route of administration. With ENTYVIO Pen, patients have the option of administering their maintenance treatment at home or on the go,” said Brandon Monk, senior vice president and head of US Gastroenterology Business Unit at Takeda Pharmaceuticals.

Takeda Pharmaceuticals. U.S. FDA approves subcutaneous administration of Takeda’s ENTYVIO® (vedolizumab) for maintenance therapy in moderately to severely active crohn’s disease. Business Wire. April 18, 2024. Accessed April 22, 2024. https://www.businesswire.com/news/home/20240401246883/en/U.S.-FDA-Approves-Subcutaneous-Administration-of-Takeda.

Abigail Brooks. FDA approves subcutaneous vedolizumab for moderate to severe UC. HCP Live. September 28, 2023. Accessed April 22, 2024. https://www.hcplive.com/view/fda-approves-subcutaneous-vedolizumab-for-moderate-to-severe-uc.

Announced on April 18, the approval is based on the VISIBLE 2 trial and comes less than 7 months after the approval of SC vedolizumab in ulcerative colitis.

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Subcutaneous Vedolizumab Approved for Moderate-to-Severe Crohn Disease

Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

Post-treatment with risankizumab, the cDAPSA score, PGA score, and PASI score substantially decreased among a cohort of patients with psoriatic arthritis. 

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Risankizumab Significantly Improves Skin, Joint Symptoms in PsA

Prolonged modified fasting, in a multimodal medical approach, may help patients with fibromyalgia improve pain and psychosomatic symptoms. 

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Prolonged Medical Fasting May Benefit Pain Symptoms in Fibromyalgia

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

Cerceo, Peden, and Ziska joined HCPLive to speak on the imminent threat posed by climate change, highlighting the impact especially on individuals with allergic disease.

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A Rising Tide: The Impact of Climate Change on Allergic Disease

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She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

Nahas reviews key highlights from her session at ACP, emphasizing the importance of reviewing patient history and considering what other factors may be causing headaches.

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Assessing Headaches in Hospitalized Patients, with Stephanie Nahas, MD, MSEd

Branch discusses key takeaways from his session at ACP and guideline recommendations for primary and secondary prevention of cardiovascular disease.

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Kelley Branch, MD: Antithrombotics in Primary, Secondary Prevention of Cardiovascular Disease

A poll found people were more likely to use alternate health care sites if they were women, aged 50 – 64 over 65 – 80 years, and had a household income of < $60,000.

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1 in 3 Older Adults Reported Using an Alternate Health Care Site

Thorndike discussed highlights from her ACP 2024 talk titled ‘Annals Beyond the Guidelines: How Would You Treat this Patient with Obesity?’


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Anne Thorndike, MD, MPH: Discussing Treatment Approaches for Patients with Obesity

An extension study showed upadacitinib 15 mg and 30 mg for rheumatoid arthritis continues to be favorable, with many patients achieving remission.

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More Than Half of RA Patients Achieve Remission After Upadacitinib 15 mg

Contrary to previous research, findings point to similar decreases in weight and improvements in glucose homeostasis between time-restricted eating and usual eating pattern groups.

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Isocaloric Time-Restricted Eating May Not Induce Weight Loss in Patients with Obesity

In this segment of his interview, Leff described what he hopes internal medicine physicians viewing his talk walk away realizing about Hospital at Home.

Latest News

Differentiating Medication Non-Adherence From Underlying Comorbidities

Defining Resistant Diabetes

Early Adherence to Glaucoma Medication Predicts Future Treatment Patterns

Eblasakimab Shows Benefit in Atopic Dermatitis Among Dupilumab-Treated Patients

Subcutaneous Vedolizumab Approved for Moderate-to-Severe Crohn Disease